Doctor: tensions, stakes high at hospital

Doctors and other health care providers at Coulee Medical Center have vowed to quit if the hospital’s chief executive officer doesn’t leave, one frustrated doctor finally told The Star last week.

Dr. Jacob Chaffee said the situation is critical and that doctors would already have resigned if they hadn’t been convinced to stay.

“He’s my fourth CEO,” Chaffee said of Chief Executive Officer Scott Graham. “I’ve never seen it like this. The morale throughout the hospital is horrible.”

In an interview Wednesday, Chaffee said he resigned as chief medical officer at the end of September, deciding his time was better spent seeing patients than trying to help make changes “from the inside.” He said his proposals over the last year were met with lip service, but no changes.

The hospital does not currently have a CMO. Dr. Andrew Castrodale is chief of staff, a position elected by the staff.

Chaffee said Castrodale would have resigned by now had not he and the staff convinced Castrodale to stay longer.

For years, the doctors have been urging management to recruit more physicians. As it is, Chaffee and Castrodale must stay within 20 minutes of the facility on call every other night and every other weekend, in addition to regular duties.

Graham says the hospital tries to recruit, but hasn’t been able to interest many because of the rural nature of the area.

Chaffee said a Dr. Shannon had been recruited but had issues with administration.

Part of the doctors’ frustration stems from a refusal to let them help in situations like that and in recruiting, and an “ongoing disconnect between the medical staff and administration.”

“There’s just been this desire to corporatize the hospital,” Chaffee said, pointing out that there are as many executive department heads (five) as there are primary care providers. “To me, that’s crazy.”

Chaffee said administation thinks the doctors are not as productive as they should be, seeing too few patients. But, he said, administrators don’t grasp the reality of the doctor/physician’s assistant approach they adopted years ago to save the facility money. CMC runs on a health care model that employs physicians, nurse practictioners, and physician’s assistants. PAs are overseen closely by physicians, who must sign off on everything a PA does, Chaffee said. That’s an administrative function that takes doctors’ time away from patients.

A method for measuring the doctors’ “relative value units” used years ago was tossed with a new administration and has never been replaced. Chaffee said the doctors’ requests for data on their own productivity have never been fulfilled, so Castordale started tracking it himself with software he paid for personally, but he still hasn’t received incentive pay for 2012.

Chaffee said at this point he has a deep lack of trust in administration.

Castrodale met with commissioners in executive session last May to explain all this, Chaffee said. Then in early October, Castrodale left the negotiating table, saying he’d had other offers, Chaffee said, but no attempt has been made by Graham since to talk with the doctors.

Chaffee said they told commission President Greg Behrens Oct. 9 that either Graham goes, or they do.

The commissioners appear split on the issue. At their last meeting, Commissioner Geary Oliver moved for a vote of no confidence against Graham, but his motion died for lack of a second. Behrens had tried to cancel that special meeting, saying it was not legal to call. Commissioners Jerry Kennedy and Kris Hare have been meeting with groups of employees, including the health care providers, to try to find a way to heal the breach.

Contacted Tuesday, Oliver said, “The board is working diligently to get this resolved.”